Early Detection and Prevention of Lung Cancer in Never Smokers
deletions, and clonal haematopoiesis can all increase susceptibility, sometimes at a young age and with multifocal lung lesions. Environmental exposures( radon, diagnostic and environmental radiation, second-hand smoke, air pollution, and some inflammatory conditions) add further risk, often with only modest individual effect sizes but substantial combined population impact.
This complexity makes it difficult to build robust risk algorithms or justify broad, expensive screening programmes in never smokers. Current data discussed in the article suggest that carefully selected high-risk groups, such as Asian women with a family history of lung cancer, may benefit from low-dose CT screening, but survival and cost-effectiveness evidence remains limited.
Early Detection and Prevention of Lung Cancer in Never Smokers
Because lung cancer in never smokers has a high rate of targetable mutations and distinct immune features, the authors argue it needs tailored research and clinical pathways. Trials are exploring earlier use of EGFR- and ALK-targeted therapies, preventive or perioperative cancer vaccines aimed at neoantigens, and immunotherapy in high-risk pre-cancer settings.
These strategies, presented in the opinion article, must balance potential gains in mortality reduction against toxicity, immune-related adverse events and health-system cost. For now, clinicians are encouraged to maintain a high index of suspicion for lung cancer in never smokers with persistent symptoms, while research moves towards more precise risk stratification, screening, and prevention for this under-recognised patient group.
Reference
Caswell DR et al. Lung cancer in never smokers: from early detection to prevention. Trends Cancer. 2026; DOI: 10.1016 / j. trecan. 2025.12.009.
Source: https:// www. emjreviews. com / en‐us / amj / respiratory / news / lung‐cancer‐in‐never‐smokersneeds‐a‐new‐approach /? utm _ source = chatgpt. com
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